Application for cancellation
of an entry in the register on
proof of discharge
• Please complete the white boxes in typescript or BLOCK LETTERS using
black ink that will not smear. No covering letter is required .
• A fee is payable for the cancellation of each entry made in the register
e.g. where an entry has been made against (say) two farmers, two fees are
payable. Fees must be paid by variable direct debit account or by cheque
or Postal Order, made payable to “Land Registry”.
• For information on how HM Land Registry processes your personal information,
see our Personal Information Charter.
(1) Please insert name of
farmer, farmers or society.
(2) Where there are two or
more farmers entered in the
register, give additional
names here. If there is not
enough space continue on the
back of the form.
(3) A branch manager or
solicitor to the bank may sign
on behalf of the bank.
(4) Please limit to 25
characters including oblique
strokes and punctuation.
I/We apply for the cancellation of the entry of the Agricultural
Charge registered against the following name or names on
under reference number
Forename(s)
(1)
Surname(s)
(2)
Signature of applicant or his/their solicitor for the above cancellation Date
We, the undersigned, being the persons authorised to agree on behalf of the bank in whose
favour the registration was made hereby agree to the cancellation of the above entry on
discharge of the charge.
(3)
Signature(s) of person(s) signing
on behalf of the bank Date
Applicant’s name and address
(including postcode)
Applicant’s
reference
(4)
Crown copyright (ref: LR/HQ) -05/18
This margin must be left clear
The Superintendent
Agricultural Credits Department
PO Box 292
PLYMOUTH PL5 9BY
DX8249 PLYMOUTH 3
AC3
(Agricultural Credits Act 1928)
• The address panel below is printed in a position so
as to fit within a standard window envelope.
For official use only
Official number
click to sign
signature
click to edit
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click to sign
signature
click to edit
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